Back problems are a large contributor to illness, pain and disability in Australia. Back problems describe a range of conditions related to bones, joints, muscles and nerves of the spine. These conditions can affect any region of the spine which include neck (cervical), mid-back (thoracic) and lower back (lumbosacral.)

Non-specific low back pain is the most common type of back pain and accounts for the majority of cases however, neck pain is also very common. Neck pain can also be non-specific which means the pain has no identifiable cause or underlying condition (such as cancer, infection, fracture or prolapsed disc). Degenerative changes (wear and tear) on spine imaging are usually considered nonspecific unless they correlate with symptoms and specific signs on examination. Cervical or neck pain can be associated with other clinically important conditions:

1. Cervical Myelopathy – caused by spinal cord compression and pressure that affects upper and/or lower limb power, sensation and sometimes bladder control. It can be a cause of progressive balance problems while walking.

2. Cervical Radiculopathy – usually described as a sharp shooting pain that radiates from the neck area down the arms, sometimes into the fingertips or between the shoulder blades.
Some known risk factors for all back pain, including the neck are:

  • Carrying excess body weight
  • Individuals who do not exercise regularly
  • Pregnancy
  • People taking part in activities that include heavy lifting or repetitive bending and twisting
  • Excessive strenuous physical activity
  • Arthritis or osteoporosis
  • Smoking

Signs & symptoms Red flags Causes of neck pain What tests are needed? How is a diagnosis made? Treatment Non-surgical treatment Spinal injections Surgical treatment

Signs & symptoms

The presence of symptoms may not indicate that an underlying identifiable or correctable disorder or condition exists. Symptoms can be quite generic in nature and range from focused pain at a particular spot or pain across the whole neck. Most neck pain resolves itself over a period of time. Chronic neck pain is the most debilitating where patients are affected over a long period of time and experience repeated flare ups.

Neck pain can be accompanied with radicular symptoms which occurs due to nerve root compression (pressure on a spinal nerve). Radicular symptoms include:

  • Sensation changes such as numbness or pins and needles (paraesthesia)
  • Weakness or motor deficit
  • Loss of spinal reflexes
  • Pain that radiates down the arm (brachalgia)

Red flags

A red flag (or ‘warning sign’) may indicate serious but uncommon disease or condition that is causing neck pain and make up the minority of cases (<5%). If red flags are identified, further medical attention is needed.
Red flag Intervention
Severe unremitting (non-mechanical) worsening of pain sometimes associated with a fever (at night and pain when laying down) Consider infection or tumour. Refer urgently to a spine surgeon.
Significant trauma Consider fractures. Check for instability and refer urgently to spinal surgeon.
Back pain with weight loss, fever, history of cancer or human immunodeficiency virus (HIV) Consider infection or tumour. Needs magnetic resonance imaging (MRI) and urgent referral to spinal surgeon.
Use of intravenous drug or steroids Consider infection or compression fracture. URGENT investigation required. In case of suspected infection, consider appropriate bloods (full blood count, an erythrocyte sedimentation rate or c-reactive protein). If blood work is positive proceed to MRI, if available. If compression fracture is suspected, proceed to standing anteroposterior and lateral x-rays. Refer urgently to a spine surgeon.
Age over 50 years, but particularly over 65 years of age (first ever episode of severe back pain) If other risk factors are for malignancy are present investigate further, refer urgently as indicated.
Widespread neurological signs Consider tumour or neurological disease – investigate further and refer urgently if indicated.

Causes of neck pain

Causes include:

  • Cervical disc prolapse (herniation/bulging)
    Download patient information sheet

  • Cervical spinal stenosis
    Download patient information sheet

  • Nerve root compression

  • Arthritic/rheumatological conditions

Functional causes of neck pain include pregnancy, obesity, unequal leg length, Hip joint pathology and other abdominal pelvic conditions.

What tests are needed?

Tests needed depend on the presentation but may include blood tests, x-rays, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scan. The MRI scan is the one radiological test that provides the most information to assist in the diagnosis and cause of neck pain, especially when brachalgia or ‘red flag’ signs are present.

When to order an MRI (this can also be ordered by Mr Gomes following consultation):

  • Failed conservative management
  • Weakness and/or sensory deficit
  • Worsening pain
  • History of cancer
  • Suspected infection

How is a diagnosis made?

Diagnosis of the cause of neck pain requires getting a good patient history, physical examination and relevant tests. Findings of the clinical examination will be correlated with relevant tests to make a diagnosis.

Treatment

In most cases, all types of back pain will improve with non-surgical treatment which should be managed by your General Practitioner (GP) and other health care professionals.

Non-surgical treatment

Non-surgical treatment for neck pain includes but is not limited to exercise, physiotherapy, clinical pilates and medication. If you have risk factors of back pain, you will be advised to make lifestyle modifications.

A comprehensive treatment plan for you must be put in place. This treatment plan will need involvement from you, your GP and other specialists such as your Physiotherapist.

Medication for neck pain may include NSAIDs, analgesics and muscle relaxants as prescribed by your doctor. Opioid analgesic agents may be appropriate in some situations.

A referral to a Pain Physician, Neurologist or Rheumatologist may be required. This will either be for further non-surgical treatment or evaluation prior to surgery.

Spinal injections

Spinal injections may be used for the investigation and treatment for neck pain with radicular symptoms. They are used to alleviate pain and can help identify the specific pain generators. These can be ordered by either the GP, in consultation with a pain physician or Mr Gomes depending on the complexity of the symptoms, signs and imaging findings.

The common forms of spinal injections include:

  • CT guided nerve root injections
  • Facet joint injections

Local anaesthetics and/or steroid is injected thought the skin at the neck under CT guidance. Patients may obtain a significant benefit and surgery can sometimes be delayed or avoided all together.

Surgical treatment

Only a very small number of patients with neck pain and radicular symptoms require surgical intervention. This will be assessed and discussed at your consultation with Mr Gomes.

Mr Gomes performs a number of surgical procedures which will be recommended taking into account the underlying condition and individual patient factors. Specific procedures are dependent on which part of the spine is affected. Refer to the specific spinal region for further detail.

Refer to Mr Gomes for consideration of surgical treatment if:

  • Suspected infection (patient should be assessed by a spine surgeon the same day)
  • Suspected/presumed tumour
  • Significant brachalgia
  • Weakness
  • Failed non-surgical treatment

For all appointments and enquiries, please phone   03 8318 4929

MAIN CONSULTING ROOMS

Mayfair Specialist Centre
Level 7
250 Victoria Parade
East Melbourne VIC 3002

ALSO CONSULTING AT

Knox Private Hospital
Suite 1A
262 Mountain Highway
Wantirna VIC 3151

Holmesglen Private Hospital
Suite A1
Paso Consulting Suites
490 South Road
Moorabbin VIC 3189

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